Parasitology Notes 4

PARASITIC NEMATODE
Parasitic nematodes are grouped into two (2) broad categories:

I. Soil transmitted nematodes: This include Ascaris lumbricoides (common round worms) as
well as the hookworms (Ancylostoma deodunale and Necator americanus).
II. Insect transmitted nematodes: This include Onchocerca volvulus, Wuchereria bancrofti,
Dracunculus medinensis (guinea worm), Loa-Loa etc.
I. ASCARIS LUMBRICOIDES (Round worms)

Host: Man
Site in Host:
Adult: They are found in the lumen of small intestine.
Larvae: Can be found sometimes in tissues of humans.
Disease: They cause the disease Ascariasis or round worm infection.
Geographical distribution and epidemiology: Cosmopolitan (worldwide) in distribution and
most common helminth infection with almost 700-900 million people infected worldwide. The
infection is rampant where sanitation is poor.
Clinical manifestations
 Usually asymptomatic
 Abdominal pain
 Lesions (wounds) in the intestine
 Obstruction (blockage) of the gut and lungs
 Malnutrition especially in children
 Growth retardation
 Asthma
 Anorexia (Loss of appetite)
 Fever (due to allergic reaction as a result of release of toxic ascaron by the adult)
Diagnosis:
 By demonstration of adult worm in faeces.
 By the demonstration of eggs in faeces or stools using direct microscopy or concentration
techniques (salt floation or formol-ether)
 By demonstration of larvae in sputum during stages of migration
 Immunodiagnosis (IFA, IHA)
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Treatment:
 Albendazole is the first line of drug.
 Levimisole
 Pamoate
 Ivermectin (a broad spectrum drug which is effective against many intestinal parasites)
Control and prevention:
 Ensure proper sewage/human faeces disposal
 Personal hygiene (washing of hands before and after eating)
 Proper preparation and washing of vegetables and salads
II. ONCHOCERCA VOLVULUS

Definitive Host: Man
Intermediate host: Simulium damnosum (black fly)
Site in host:
 Adult: The adult worm is found in the subcutaneous tissue (Skin) and form tangle of
masses called nodules (Onchocercal nodules).
 Microfilariae (Young worm): usually found in the subcutaneous tissue or under the skin
and not in blood. The microfilariae of onchocerca volvulus is unsheath.
Disease: Onchocerciasis, riverblindness
Geographical distribution and epidemiology:
 West Africa, Central Africa, South and Central America and in Yemen.
 It is estimated that about 20 million people are known to be infected with Onchocerca
volvulus worldwide and about 350,000 people are known to be blinded by the disease and
500,000 have severe visual impairment worldwide.
 It is reported to be second most commonly blinding disease in the world.
 The disease is found in areas very close to river and mostly fast flowing water bodies as
the vector Simulium breeds in those areas, hence the name “river blindness”.
Clinical manifestations:
 Leopard skin
 Nodules (often movable)
 Loss of skin elasticity
 Thickening of the skin
 Elephant skin
 Hanging groin
 Blindness
2
Diagnosis:
 By taking skin snip (biopsy) during the day and not at night.
 Demonstration of adult worm (males/females or dead worms) in incised nodule
 Seological tests
 Polymerase Chain Reaction to detect microfilarial antigens in skin samples
 By DEC (Direct Epithelial cell count) patch test.
Treatment:
 Ivermectin or Mectizan(R) (Broad spectrum drug) which is effective only against
microfilaria
 Use of Diethylcarbamazine
 Albendazole
 Suramin (Very effective but has serious side effects)
 Anti-inflammatory drugs
 Moxidectin (a new drug undergoing research and is effective against the adult worm)
Prevention and control:
 Control of the disease is mainly against the vector Simulium fly by using DDT and
ABATE to kill the larval stages.
III. WUCHERERIA BANCROFTI

Host: Man
Intermediate host: Culex Quinquefasciatus (more than 50% of cases), Aedes and also Anopheles
mosquito
Site in host:
 Adult: Adult worms are found in the lymph nodes and lymphatic vessels (groin and upper
limb).
 Microfilariae are found in blood and sometimes in the lymphatic fluids and urine.
Disease: Lymphatic filariasis, Wucheriasis, Elephantiasis or Bancroftian filariasis. The disease is
also called Hydrocoel in English and Tundirmi in Hausa.
Geographical distribution and epidemiology:
 The disease is endemic in 80 countries. In Africa between 20 o North and 20o South of the
equator, Asia, South and Central America, Australia, Pacific Islands.
 More than 40% of all infected are found in India (mostly among women) and other
percentage are found in Africa.
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 The disease is rarely life threatening. It causes clinical manifestations with widespread
sufferings, disability and social stigma.
Clinical manifestations:
 Asymtomatic (Hidden damage to the lymph vessels) as well as the kidney
 Filarial fever
 Headache and pain
 Inflammation of the lymph nodes and ducts
 Elephantiasis (due to blockage of the lymphatic or lymph vessels by the adult worm
 Swelling of the scrotum in male (Hydrocoel)
 Enlargement of the breast in female
 Epididymitis
 Malaise
Diagnosis:
 This can be done by detecting the presence of microfilariae in blood at night only
(nocturnal periodicity). The blood sample usually taken between 9pm – 2am.
 Adult worm can be detected by X-ray examination
 Adult detected in biopsied lymph node
 Immunodiagnosis (ELISA)
 DNA probes
Treatment:
 The first line drug is the combination of Ivermectin and Albendazole (single dose)
 Levimisole
 Diethylcarbamazine (DEC)- single dose
 Anti-inflammatory drugs
 Surgery
Control and prevention:
 Avoidance of mosquito bites in endemic areas through the use of insects repellants,
bednets, insecticides
 Sanitation and environmental management to minimize mosquito breeding places
 Promotion of vigorous and hygiene
 Development of techniques on elephantiasis to prevent and alleviate suffering of
individuals
 Mass drug administration of drugs to at risk population once a year, one day treatment to
interrupt the transmission

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PARASITIC NEMATODE

Parasitic nematodes are grouped into two (2) broad categories:

I. ASCARIS LUMBRICOIDES (Round worms)

II. ONCHOCERCA VOLVULUS

III. WUCHERERIA BANCROFTI

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